Product information and disease description Place of product in therapy Disease description Burden of Schizophrenia

Economic burden and healthcare resource utilization

25 evidence topics · 22 sources

United States economic burden in 2019: total and per-person excess costs

“Given a prevalence estimate of 1.19%, the schizophrenia population in the US in 2019 was estimated to be 3,906,050, contributing to an excess economic burden of $343.2 billion (Figure 1, Table 2), which corresponded to an annual excess cost per person with schizophrenia of $87,856.” (opens the source at this quote in a new tab)
“The excess direct health care costs were $62.3 billion ($15,957 per person with schizophrenia), the excess direct non–health care costs were $35.0 billion ($8,956 per person with schizophrenia), and the excess indirect costs were $251.9 billion ($64,479 per person with schizophrenia) (Figure 1).” (opens the source at this quote in a new tab)
“Using a lifetime prevalence rate of 0.72%,3 the schizophrenia population in the US in 2019 was estimated to be 2,363,325, contributing to an excess economic burden of $215.1 billion (Table 2).” (opens the source at this quote in a new tab)

United States economic burden in 2019: direct health care costs by service category and by payer

“Excess direct health care costs were estimated to be $62.3 billion and included costs associated with pharmacy ($12.1 billion), outpatient care ($12.9 billion), inpatient care ($30.2 billion), emergency department visits ($5.6 billion), long-term care ($1.5 billion), and other medical services ($120.6 million) (Table 2).” (opens the source at this quote in a new tab)
“Among these patients, 24,881 (19.0%) were commercially insured, 2,779 (2.1%) were Medicare-insured, and 103,465 (78.9%) were Medicaid-insured (Table 3).” (opens the source at this quote in a new tab)
“Mean total health care costs were similar across the commercially insured and Medicaid-insured cohorts but were higher for Medicare-insured patients ($26,904, $26,095, and $34,391, respectively) (Table 4).” (opens the source at this quote in a new tab)
“Mean excess health care costs varied across cohorts, with the greatest excess among commercially insured patients ($19,293), followed by Medicaid- and Medicare-insured patients at $15,347 and $11,963, respectively.” (opens the source at this quote in a new tab)

United States economic burden in 2019: law enforcement, incarceration, homeless shelter, and disability income costs

“Excess law enforcement costs were estimated to be $26.1 billion, including $8.2 billion in police protection, $4.6 billion in judicial and legal services, and $13.3 billion in incarceration costs.” (opens the source at this quote in a new tab)
“Excess homeless shelter costs were estimated to be $2.1 billion, corresponding to homeless shelter costs for 139,410 excess sheltered homeless individuals with schizophrenia.” (opens the source at this quote in a new tab)
“Excess costs related to SSI and SSDI were estimated to be $6.5 billion, accounting for mean annual SSI and SSDI payments of, respectively, $7,317 and $11,234 per schizophrenia patient.” (opens the source at this quote in a new tab)

United States economic burden in 2019: indirect costs and change since 2013

“Excess indirect costs accounted for 73.4% ($251.9 billion) of the total economic burden of schizophrenia (Figure 1, Table 2).” (opens the source at this quote in a new tab)
“Costs due to premature mortality, unemployment, and productivity loss totaled $77.9 billion, $54.2 billion, and $7.4 billion, respectively.” (opens the source at this quote in a new tab)
“These findings suggest that the total estimated burden of schizophrenia doubled (+100.9%) between 2013 and 2019 (after adjusting for inflation).” (opens the source at this quote in a new tab)
“The increase in direct health care costs (+50.7%) was primarily driven by a $13.5 billion increase in inpatient costs (+80.9%) and a $4.8 billion increase in outpatient costs (+58.8%).” (opens the source at this quote in a new tab)

United States economic burden in 2013

“The economic burden of schizophrenia was estimated at $155.7 billion ($134.4 billion-$174.3 billion based on sensitivity analyses) for 2013 and included excess direct health care costs of $37.7 billion (24%), direct non-health care costs of $9.3 billion (6%), and indirect costs of $117.3 billion (76%) compared to individuals without schizophrenia.” (opens the source at this quote in a new tab)
“The largest components were excess costs associated with unemployment (38%), productivity loss due to caregiving (34%), and direct health care costs (24%).” (opens the source at this quote in a new tab)

Medicaid: national utilization and per-patient costs in 2018

“The AP utilization rate was 51% (state range: 24-77%), while the LAI utilization rate was 13% (range: 4-26%).” (opens the source at this quote in a new tab)
“The proportion of patients with ≥1 inpatient admission and ≥1 emergency room visit was 34% (range: 19-82%) and 45% (range: 20-70%).” (opens the source at this quote in a new tab)
“Per-patient-per-year total healthcare costs averaged $32,920 (range: $717-$93,972).” (opens the source at this quote in a new tab)

Medicare fee-for-service: national utilization and per-patient costs in 2019

“About 91% used any AP; 20% used any long-acting injectable antipsychotic (LAI); and 14% used atypical LAIs.” (opens the source at this quote in a new tab)
“About 28% of beneficiaries had ≥1 hospitalization and 47% had ≥1 emergency room (ER) visits, the vast majority of which were related to mental health (MH).” (opens the source at this quote in a new tab)
“Total annual all-cause, MH, and schizophrenia-related costs were $23,662, $15,000 and $12,109, respectively.” (opens the source at this quote in a new tab)

Medicare fee-for-service: costs relative to the general Medicare population, 2003 to 2009

“Although adults with schizophrenia make up approximately 1% of the US adult population, they represent about 1.5% of Medicare beneficiaries.” (opens the source at this quote in a new tab)
“The cost of care for MBSs in 2009 was, on average, 80% higher than for the average GMB per patient year (2010 dollars), and more than 50% of these costs are attributable to a combination of psychiatric and medical hospitalizations, concentrated in about 30% of MBSs with 1 or more hospitalizations per year.” (opens the source at this quote in a new tab)
“From 2004-2009, total estimated Medicare fee-for-service payments for MBSs increased from $9.4 billion to $11.5 billion, excluding Part D prescription drugs and payments for services to MBSs in Medicare for less than 1 year.” (opens the source at this quote in a new tab)

Medicare Part D: out-of-pocket costs for oral and long-acting injectable antipsychotics by low-income subsidy status

“In the final sample, 90.3% of beneficiaries had full LIS status, paying minimal copayments (29.6% institutionalized full LIS, paying $0; 42.2% noninstitutionalized full LIS, ≤100% federal poverty level [FPL], paying $1.25-$3.80; and 18.5% noninstitutionalized full LIS, >100% FPL, paying $3.40-$8.50).” (opens the source at this quote in a new tab)
“Before entering catastrophic coverage, median OOP costs per prescription for generic OAPs, brand-name OAPs, FGA-LAIs, and SGA-LAIs were $10.85, $171.97, $26.09, and $394.28, respectively, for non-LIS beneficiaries and $3.69, $105.82, $9.35, and $229.20, respectively, for partial LIS beneficiaries.” (opens the source at this quote in a new tab)
“The annual total OOP costs varied substantially by LIS status (full LIS, $0-$130.79; partial LIS, $458.96; non-LIS, $998.81).” (opens the source at this quote in a new tab)

Commercial insurance: per-patient costs, cost shares by service category, and utilization

“A total of 8985 patients with schizophrenia met the inclusion criteria for the snapshot analysis.” (opens the source at this quote in a new tab)
“The mean cost per patient per month (PPPM) for a patient with schizophrenia was $1806 versus $419 per member per month for the demographically adjusted nonschizophrenic (ie, matched for age and sex) population.” (opens the source at this quote in a new tab)
“The PPPM cost of $1806 for patients with schizophrenia was 42% for inpatient expenditures, 33% for outpatient, and 25% for prescription drug costs.” (opens the source at this quote in a new tab)
“The annual inpatient admission rates were 636 per 1000 patients with schizophrenia and 48 per 1000 persons for the demographically adjusted population without schizophrenia.” (opens the source at this quote in a new tab)
“The annual emergency department visits for patients with schizophrenia were 2270 per 1000 patients and 158 per 1000 persons without schizophrenia for the demographically adjusted population.” (opens the source at this quote in a new tab)
“The highest costs occurred in the month of diagnosis (designated as the index month; mean cost, $6601).” (opens the source at this quote in a new tab)

Commercial insurance: adherence and costs in a systematic literature review of privately insured patients

“A total of 25 studies were reviewed; 10 included only privately insured patients; and 15 included a mix of different types of insurance.” (opens the source at this quote in a new tab)
“Antipsychotic (AP) adherence was low, ranging from 31.5% to 68.7%.” (opens the source at this quote in a new tab)
“patients with a recent (vs. chronic) diagnosis of schizophrenia had significantly higher frequencies of emergency department visits and hospitalizations and greater length of stay (LOS) and total annual per-capita costs.” (opens the source at this quote in a new tab)

Integrated health system: hospitalization, readmission, and emergency room use

“The study cohort included 2,941 patients (mean age, 48.3 years; 54.5% male, 51.8% black, 45.8% with Medicare).” (opens the source at this quote in a new tab)
“During the follow-up period (mean, 4.6 years), inpatient hospital stays were common, with at least one all-cause, mental health-related, or schizophrenia-related inpatient visit occurring for 48.7%, 47.3%, and 38.8% of patients, respectively.” (opens the source at this quote in a new tab)
“Hospital readmissions within 30 days of an all-cause inpatient visit occurred in 20.4% of patients, with 14.5% of patients readmitted within 30 days of a schizophrenia-related inpatient visit.” (opens the source at this quote in a new tab)

Cost of relapse: Medicaid beneficiaries with recent relapse or with nonadherence and uncontrolled symptoms

“Among 158,763 patients with schizophrenia, 18,771 (11.8%) had a recent relapse (mean age 50.5 years; 48.6% female, 51.4% male) and 13,697 (8.6%) were not adherent to APs and had uncontrolled symptoms of schizophrenia (mean age 47.1 years; 48.0% female, 52.0% male).” (opens the source at this quote in a new tab)
“Patients with recently relapsed schizophrenia had mean total healthcare costs $21,862 higher relative to their controls ($37,424 vs $15,563), driven by $8,486 higher mean long-term care costs (all P < 0.001).” (opens the source at this quote in a new tab)
“Patients non-adherent to APs with uncontrolled symptoms of schizophrenia had adjusted mean total healthcare costs $20,787 higher relative to their controls ($38,337 vs $15,241), driven by $8,019 higher adjusted mean inpatient costs (all P < 0.001).” (opens the source at this quote in a new tab)
“Additional total healthcare costs incurred by patients with recently relapsed schizophrenia and those of patients non-adherent to APs with uncontrolled symptoms of schizophrenia exceeded by 55.2% and 47.6%, respectively, incremental total healthcare costs incurred by all patients with schizophrenia ($14,087).” (opens the source at this quote in a new tab)

Cost of relapse: United States prospective observational study

“Of 1,557 participants with eligible data, 310 (20%) relapsed during the 6 months prior to the 1-year study period.” (opens the source at this quote in a new tab)
“Compared to patients who did not experience prior relapse, patients with prior relapse incurred significantly higher total annual direct mental health care costs during the 1-year study period, which were nearly 3 times higher for the relapsed ($33,187 ± $47,616) compared with those who did not ($11,771 ± $10,611, p < .01).” (opens the source at this quote in a new tab)
“Inpatient costs for patients with a relapse during both the prior 6 months and the follow-up year were 5 times the costs for patients with relapse during the follow-up year only.” (opens the source at this quote in a new tab)

Cost of relapse: range across studies in a systematic review

“We found 16 studies reporting costs associated with relapse over a defined period of time and identified a cost associated with hospitalisation for relapse in 43 studies.” (opens the source at this quote in a new tab)
“Studies from the US report excess costs of relapse of $6033-$32,753 (2015 Purchasing Power Parity dollars [PPP$]) over periods of 12-15 months.” (opens the source at this quote in a new tab)

Inpatient stays: cost per stay and length of stay, United States, 2016

“Alcohol-related disorders and schizophrenia each constituted nearly one in five MSUD stays.” (opens the source at this quote in a new tab)
“Inpatient stays for schizophrenia were the second costliest ($8,900 per stay) and second longest (11 days on average) MSUD stay.” (opens the source at this quote in a new tab)
“Schizophrenia was the most common reason for MSUD stays for males aged 18-44 years.” (opens the source at this quote in a new tab)

Readmissions: 30-day all-cause readmissions after Medicaid index admissions for schizophrenia spectrum and other psychotic disorders, 2018

Metric	Value
Number of index admissions	“166,100”
Rank among Medicaid principal diagnoses by number of readmissions	“2”
Number of 30-day readmissions	“39,300”
Readmission rate, percent	“23.7”
Percent of total Medicaid readmissions	“5.4”

“For both Medicaid and self-pay/no charge, two of the five diagnoses with the most readmissions were mental and/or substance use disorders: alcohol-related disorders (Medicaid and self-pay/no charge), schizophrenia (Medicaid), and depressive disorders (self-pay/no charge).” (opens the source at this quote in a new tab)

Readmissions: incidence and cost in the 2014 Nationwide Readmissions Database

“A total of 77 625 of 343 579 (22%) index hospital discharges for SPDs resulted in readmissions.” (opens the source at this quote in a new tab)
“The average index and readmission costs were $9285 and $8593, respectively.” (opens the source at this quote in a new tab)

Emergency department visits related to schizophrenia: United States, 2009 to 2011

“During 2009–2011, an estimated 382,000 emergency department (ED) visits related to schizophrenia occurred each year among adults aged 18–64, with an overall ED visit rate of 20.1 per 10,000 adults.” (opens the source at this quote in a new tab)
“Public insurance (Medicaid, Medicare, or dual Medicare and Medicaid) was used more frequently at ED visits related to schizophrenia compared with ED visits not related to schizophrenia.” (opens the source at this quote in a new tab)
“About one-half of ED visits related to schizophrenia led to either a hospital admission (32.7%) or a transfer to a psychiatric hospital (16.7%); these percentages were higher than for ED visits not related to schizophrenia.” (opens the source at this quote in a new tab)

Treatment-resistant schizophrenia: costs relative to schizophrenia overall

“Sixty-five studies were identified.” (opens the source at this quote in a new tab)
“Annual costs for patients with schizophrenia are $15 500-$22 300 and are 3-11-fold higher for patients with TRS.” (opens the source at this quote in a new tab)
“Although estimates in the literature vary greatly, TRS conservatively adds more than $34 billion in annual direct medical costs in the USA.” (opens the source at this quote in a new tab)

Nonadherence: national rehospitalization costs

“Seven studies were identified and reviewed based on the study design, measurement of medication nonadherence, study setting, and cost outcome results.” (opens the source at this quote in a new tab)
“We also estimated that the national rehospitalization costs related to antipsychotic nonadherence was $1479 million, ranging from $1392 million to $1826 million in the US in 2005.” (opens the source at this quote in a new tab)
“The estimate of rehospitalization costs was restricted to schizophrenia patients from the Medicaid program.” (opens the source at this quote in a new tab)

Antipsychotic adverse effects: hospitalization and costs associated with extrapyramidal symptoms in Medicaid

“A total of 11,642 patients with schizophrenia filled a prescription for an SGA; of which, 2,468 (21.2%) experienced EPS in the first year.” (opens the source at this quote in a new tab)
“Multivariate analyses confirmed that EPS patients had 25% higher odds of all-cause (OR = 1.25; 95% CI = 1.11-1.40) and 75% increased odds of schizophrenia-related (OR = 1.75; 95% CI = 1.53-2.00) inpatient admissions compared to non-EPS patients.” (opens the source at this quote in a new tab)
“Multivariate adjustment of post-period costs between groups also found significant differences in both all-cause (EPS: $27,408 vs. non-EPS: $22,489, p < 0.001) and schizophrenia-related (EPS:$12,833 vs. non-EPS:$8,077, p < 0.0001) costs between the EPS and non-EPS cohorts.” (opens the source at this quote in a new tab)

Antipsychotic adverse effects: healthcare costs after new-onset metabolic disorders following oral antipsychotic initiation

“A total of 45,528 individuals with schizophrenia qualified for the study, and 34.7% developed metabolic disorders within 6 years after initiating OAPs.” (opens the source at this quote in a new tab)
“Compared to a matched cohort of individuals without metabolic disorders, individuals with a metabolic disorder incurred significantly greater all-cause annual healthcare costs (mean [standard deviation] in 2023 US dollars, $27,520 [$44,200] vs. $19,044 [$34,352]; p < 0.0001) during the 12-month post-index period.” (opens the source at this quote in a new tab)

Negative symptoms: healthcare resource utilization and costs in linked records and claims

“A total of 79,326 patients were enrolled in the EHR cohort and 14,992 (18.9%) had documented negative symptoms.” (opens the source at this quote in a new tab)
“Patients with documented negative symptoms had more HCRU including days hospitalized, outpatient visits, and all-cause healthcare claims than patients without documented negative symptoms (all P < .001).” (opens the source at this quote in a new tab)

Criminal justice system involvement: prevalence and per-patient cost

“Overall, 278 (46%) of 609 participants reported at least 1 criminal justice system encounter.” (opens the source at this quote in a new tab)
“The 2 most prevalent types of encounters were being a victim of a crime (67%) and being on parole or probation (26%).” (opens the source at this quote in a new tab)
“The mean annual per-patient cost of involvement was $1,429, translating to 6% of total annual direct health care costs for those with involvement (11% when excluding crime victims).” (opens the source at this quote in a new tab)

Share of antipsychotic pharmacy spending attributable to branded oral atypical antipsychotics and long-acting injectables

No evidence found.